The Role of Amplitude-Integrated Electroencephalography (aEEG) in Monitoring Infants with Neonatal Seizures and Predicting Their Neurodevelopmental Outcome

Abstract

Newborn monitoring in neonatal intensive care units (NICU) is mandatory, but neurological and especially electroencephalographic (EEG) monitoring can be overlooked or delayed until the newborn is clinically stable. However, the neonatal period is associated with the highest risk of seizures in humans, and the clinical symptoms may often be discrete, but the evolution and long-term neurodevelopmental disorders in these patients may be important. In response to this issue, we conducted a study to evaluate newborns who experienced neonatal seizures (NS) in the NICU and monitored their long-term neurological development. We enrolled 73 term and preterm newborns who underwent EEG monitoring using amplitude-integrated electroencephalography (aEEG). We then followed their neurological development until around 18 months of age, with 59 patients remaining in the long-term study. A total of 22% of patients with NS developed epilepsy, 12% cerebral palsy, 19% severe neurodevelopmental disabilities, and 8.5% died within the first 18 months of life. Our findings indicate that aEEG background pattern is a strong predictor of unfavorable neurological outcomes, with an odds ratio of 20.4174 (p < 0.05). Additionally, higher Apgar scores were associated with better outcomes (p < 0.05), with the odds of unfavorable neurological outcomes decreasing by 0.7-fold for every point increase in Apgar score. Furthermore, we found a statistically significant association between preterm birth and unfavorable neurological outcomes (p = 0.0104). Our study highlights the importance of early EEG monitoring in the NICU and provides valuable insights into predictors of unfavorable neurological outcomes in newborns who experienced NS.

Early Postnatal Administration of Erythropoietin and Its Association with Neurodevelopmental Outcomes and Incidence of Intraventricular Hemorrhage and Hypoxic-Ischemic Encephalopathy: A Four-Week Observational Study

“…The neurological development of newborns is a complex process that is susceptible to a variety of insults, including hypoxia-ischemia, inflammation, and hemorrhage [ 5 , 6 , 7 ]. Complications such as intraventricular hemorrhage (IVH) are more prevalent in preterm infants due to the fragility of their cerebral blood vessels [ 8 ] which, even though not being easily preventable due to very early onset peri- and postpartum, are hypothesized to cause less harm in the context of early EPO administration [ 9 , 10 ].…”

Neuropsychology and Electroencephalography in Rural Children at Neurodevelopmental Risk: A Scoping Review

“…The literature suggests that neonatal mortality and morbidity are higher in rural and marginalized regions due to economic constraints, the absence of specialized obstetric and neonatal services, and the lack of awareness of the dangers to maternal and fetal health during pregnancy [28], which are linked to a higher prevalence of risk factors for early brain damage such as very preterm birth, low birth weight, hypoxic-ischemic encephalopathy, exposure to substances and maternal diseases, as well as septic processes [29]. In the case of the presence of early signs of neonatal seizures, EEG monitoring provides predictors related to unfavorable neurological signs, particularly in infants who experienced perinatal risks [30]. All these variables have been associated with an increased risk of neurocognitive developmental disorders.…”

Neuropsychology and EEG in Rural Children at Neurodevelopmental Risk: Meta-Analysis

“…The literature suggests that neonatal mortality and morbidity are higher in rural and marginalized regions due to economic constraints, the absence of specialized obstetric and neonatal services, and the lack of awareness of the dangers to maternal and fetal health during pregnancy [20], which are linked to a higher prevalence of risk factors for early brain damage such as very preterm birth, low birth weight, hypoxic-ischemic encephalopathy, exposure to substances and maternal diseases, as well as septic processes [21]. In the case of the presence of early signs of neonatal seizures, EEG monitoring provides predictors related to unfavorable neurological, particularly in infants who experienced perinatal risks [22]. All these variables have been associated with an increased risk of neurocognitive developmental disorders.…”